RS11 - Thoracic Endovascular Aortic Repair for Metachronous Thoracic Aortic Aneurysms Following Prior Infrarenal Abdominal Aortic Aneurysm Repair

Thursday, June 15, 2023

11:09 AM – 11:16 AM ET

Submitting & Presenting Author(s)

SY

Sai Divya Yadavalli, MD (she/her/hers)

Postdoctoral Research Fellow
Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, Massachusetts

Co-Author(s)

VR

Vinamr Rastogi, MD

Department of Vascular Surgery, Erasmus University Medical Center
Rotterdam, The Netherlands
Winona W. Wu, MD

Integrated Vascular Surgery Resident
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center
Boston, Massachusetts
Sara Allievi, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, Massachusetts
DJ

Douglas W. Jones

Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center
Worcester, Massachusetts
Salvatore T. Scali, MD (he/him/his)

Professor of Surgery
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine
Gainesville, Florida
HV

Hence J.M. Verhagen

Professor
Department of Vascular Surgery, Erasmus University Medical Center
Rotterdam, The Netherlands

Senior Author(s)

Marc L. Schermerhorn, MD (he/him/his)

Chief of Vascular and Endovascular Surgery
Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, Massachusetts

Objectives: Thoracic Endovascular Aortic Repair (TEVAR) for metachronous thoracic aortic aneurysms (M-TAA) following prior AAA repair has been shown to be associated with higher risk of spinal cord ischemia compared with primary TEVAR. However, data regarding the impact of the type of prior repair on outcomes are scarce. In this study, we examined perioperative outcomes and long-term mortality following TEVAR for M-TAA compared with primary TEVAR for TAA.

Methods: We identified all patients who underwent TEVAR for TAA of the descending thoracic aorta in the VQI from 2013-2022. Only patients undergoing primary TEVAR or TEVAR following infrarenal open (iOAR) or endovascular (EVAR) repair were included. We performed univariate analyses to identify differences in baseline and procedural characteristics, and multivariable analyses for perioperative outcomes and 5-year mortality using logistic and Cox regression models.

Results: We included 1,493 patients who underwent primary TEVAR (n=1213; 81%) or TEVAR following prior iOAR (n=135; 9%) or prior EVAR (n=145; 10%). Compared with primary TEVAR, patients undergoing TEVAR for metachronous aneurysms were older, more commonly male, white, and more frequently had a history of genetic disorders and other comorbidities. M-TAA patients were more often asymptomatic at repair, presented with larger diameters, and required higher contrast volume and longer procedural time, relative to patients undergoing primary TEVAR. Following risk-adjustment, compared with primary TEVAR, prior EVAR was associated with higher perioperative mortality (10% vs 3.9%, OR: 4.5 [95% CI: 2.0-9.9]; p<.001 | Table I) and 5-year mortality (40% vs. 24%, HR: 1.9 [95% CI: 1.3-2.]; p=.001 | Fig 1), along with higher odds of acute kidney injury (10% vs 6.2%; OR: 2.0 [95% CI: 1.0-3.8]; p=.04). However, other in-hospital complications including spinal cord ischemia were not notably different. On the other hand, TEVAR after prior iOAR was associated with similar perioperative mortality (4% vs 4%, OR: 0.8 [95% CI: 0.3-2.0]; p=.75), 5-year mortality (28% vs. 24%, HR: 1.2 [95% CI: 0.72-1.9]; p=.54), and in-hospital complication and reintervention rates, relative to primary TEVAR.

Conclusions: Type of prior repair has significant impact on outcomes in patients undergoing intervention for M-TAA. Further efforts should aim to identify the reasons behind these differences in outcomes to help improve care of M-TAA patients.